Diabetes Health

Exams of Obese, Diabetic Youth Show Cardiovascular Problems

An examination of the neck arteries of today's obese or diabetic young people bodes ill for their future health, researchers report in the journal Circulation.

The walls of the carotid arteries, which carry blood to the brain, showed a thickening and stiffness known to increase the risk of future strokes, heart attacks, and other cardiovascular problems.

"Since the 1980s, there has been a major increase in obesity in our youth," says Dr. Elaine Urbina, director of preventive cardiology at Cincinnati Children's Hospital Medical Center and lead author of the report.

"This could be the first generation of Americans that has a shorter life expectancy than its parents," she says.

Obese and Lean Children Compared

In the study, Dr. Urbina and her team used ultrasound to assess the carotid arteries of a few hundred young people (average age 18) - 182 who were lean, 128 diagnosed with type 2 diabetes (often tied to obesity), and 136 classified as obese because their weight-for-height was above the 95th percentile.

"It was one of the larger studies of carotid thickness in adolescents," says Dr. Urbina.

The researchers looked at the thickness of the intima, one of the layers of tissue that line the arteries.

"If you have diabetes, the intima is thicker than if you don't have diabetes," explains Dr. Urbina. "If you are obese, the artery is also thicker. Stiff carotids are linked to heart attacks as well as strokes, because if you are having a buildup of plaque in the arteries that lead to the brain, you probably are having a buildup in the coronary arteries as well."

Plaque is the term for the fatty deposits that can increase in size and thickness until they limit or totally block normal blood flow.

The young people who were obese or had diabetes were more likely to have other risk factors for cardiovascular disease, such as higher blood pressure and high levels of blood fats such as cholesterol, the study found. But those factors did not account for the significant changes in artery structure and function, the researchers say.

According to Dr. Urbina, the detection of unhealthy artery changes in young, obese, or diabetic people "demonstrates the need for research in this area."

One expert said the findings reinforce prior research.

"This is more evidence that obesity is not good for young people," says Dr. Robert H. Eckel, a spokesman for the American Heart Association. However, it is not clear from the study how damaging obesity might be in these young people, he notes.

"How important [the findings are] in terms of what is to follow is not clear," he says, noting that the consequences of obesity in childhood on adult health are not set in stone.

"There can be intervention to modify risk, not necessarily to reduce obesity but to control blood pressure and blood lipids more aggressively. I would like to see further studies that follow these young people with and without intervention for 10 years," says Dr. Eckel.

Lifestyle Still a Key Factor

In the meantime, rising childhood obesity is now a troubling fact of life for physicians who see young patients.

The child and youth obesity problem is an issue for schools as well as parents.

Schools must play a role, because "80 percent of the calories children consume are outside the control of parents," Dr. Urbina says, and also because schools often do not emphasize physical activities that can help prevent excess weight gain.

August 2009

Facts on Obesity

According to the National Center for Health Statistics, about 19 percent of children ages 6 to 11 in the US are considered overweight and 17 percent of teenagers (ages 12 to 19) are overweight. More people are now overweight than 15 years ago. This increase is seen in both sexes and all ages. Individuals who are obese as adolescents will most likely remain obese as they become older.

Obesity is defined as a generalized accumulation of body fat. Obesity is determined by measuring both the height and weight of the child. A child or adolescent is considered obese if he/she is significantly over the ideal weight for his/her height.

Overweight is defined as increased body size with increased lean body mass and without excess accumulation of body fat. A uniform standard to separate obesity from overweight has not been established. Research studies suggest that overweight children and adolescents may become overweight adults.

The basis of treatment for obesity in children and adolescents involves diet changes and exercise. It is important for parents and the adolescent to be ready and willing to make the change.

Generally, weight loss is not recommended for babies and young children who are still growing and developing. The goal of treatment for these children is to maintain their weight while they continue to grow taller.

Weight reduction may be recommended for obese adolescents who have completed their growth. The following are some of the general guidelines that may be followed in treating your child and adolescent:

For children older than age seven the goal is to maintain baseline weight initially, and then add slow changes in eating and exercise to achieve slow weight loss as recommended by your child's physician.

At this age, a child or adolescent should follow adult guidelines, and limit fat intake.

Your child needs enough calories to maintain his/her energy level, but no more than he/she can burn off. This is called an energy balance. If he/she takes in more calories than he/she burns, he/she gains weight. If he/she takes in fewer calories than he/she burns, he/she loses weight. If he/she balances the two, he/she maintains his/her weight.

Even when dieting, however, calories should not be cut back so much that your child's energy needs are not met. The number of calories your child needs depends primarily on age, gender, and activity level.

Decrease consumption of high-fat foods. Eat more vegetables and fruits.